Portland Patient Forms

Seattle

We have enjoyed working with and serving our patients and clients
in the Seattle metro area for the last 25 years. Unfortunately,
we have made the difficult decision to close our Seattle office.
Our last day of operation in Seattle, Washington will be December 15, 2016.

This decision has no impact on our Portland site where we continue
to working together for better future treatments and better health.
If you have questions or would like to be involved in our studies at our Portland office, please contact us.

Contact Us

Items marked with * are required

Receipt Email

user-email

First Name*

Middle Initial

Last Name*

Gender

Male

Female

Date of Birth

If contacting us about a pediatric study:

Child’s Name

Child’s Age

(Area Code) and Phone*

Cell Phone

May we text you?*

Yes

No

Email*

Zip Code

Best time to call?

How did you hear about us?

Comments

Note: We will respond to your email within 2 business days. If you have not received a response within that time, please check the Spam folder in your email program.